Interview with prof. dr. hab. n. med. Paweł Buszman, cardiologist, president of the Board of the Polish-American Heart Clinics. Professor Buszman started his work in Zabrze in the 1980s, where an intensive heart attack treatment program was being created. He was a pioneer in placing coronary stents and was the first in Poland to implant a stent into the carotid artery.
Prof. . dr. hab. n. med. Paweł Buszman, cardiologist.
- Annually in Poland, about 90,000 people suffer from a heart attack, of which about 20,000 die. How far are we from controlling coronary heart disease?
Unfortunately, it is very far away, because treating a heart attack is not a one-time life-saving action, but a process that consists of many stages, requires time, constant medical supervision and financial outlays. 10 years ago, when the limits for the treatment of acute coronary syndromes in Poland were lifted, it seemed that we were moving towards improving the statistics.
We have trounced the success of treating acute coronary syndromes, but cardiology has begun to restrict access to funding.
Suddenly there were voices that the treatment of heart attacks is a great business, so it is eagerly chosen, and yet coronary artery disease in developed countries, including Poland, has taken the size of an epidemic. It is the most commonly diagnosed cardiovascular disease. In most European countries, it affects 20,000-40,000 people per million inhabitants. However, due to the aging of the population and the emergence of disease risk factors in younger and younger people, the number of patients (and thus - the number of deaths) is systematically increasing. According to the World He alth Organization (WHO), mortality from ischemic heart disease will increase from 7.1 in 2002 to 11.1 million in 2022. Meanwhile, we in Poland suddenly stopped noticing it and for 10 years we have neither had modern drug therapy nor, most importantly, financing for the completion of treatment of a patient with acute coronary syndrome.
- What's thismeans?
For example, the fact that a patient leaves the hospital after a heart attack is advised to report to a cardiology clinic for a check-up in a month's time. But he gets the term in a year. Meanwhile, the highest mortality rate after a heart attack is the first three months to a year.
In Poland, due to lack of funds to complete the treatment, 15-18 percent patients die within a year after a heart attack, when, for example, in Sweden only 9-10 percent.
Another scandal is the fact that cardiologists were deprived of the possibility of performing certain procedures, although it is a phenomenon on a global scale. Example: a patient comes with a narrowed coronary artery, we treat, we put a stent on, we open it, but 40-50 percent. patients also have the same changes in peripheral vessels. For a year, after the completely absurd announcement came into force, we have not been able to unblock them during the same procedure. This is not the end, a large number of patients have severe heart damage, requiring further therapy after a heart attack - implantation of anti-arrhythmic devices - automatic cardioverter - defibrillators, resynchronization devices or pacemakers, preventing complications such as atrioventricular blocks, etc. There is no money for this. We cannot carry out practically any scheduled admissions of people before a heart attack to protect them from it. Sometimes the treatment is completed with a cardiac surgery, for streaks or repair of a damaged valve, and finally with cardiological rehabilitation. It is true that there are funds for rehabilitation in the Fund, but many patients cannot be sent without completing the treatment, because such an effort will kill them!
- Is the professor suggesting that Polish cardiology is taking a step back?
That's exactly what it is. 15 years ago, we made a leap forward, introduced new treatments, built many centers, improving access to modern treatment, 10 years ago we freed the treatment of myocardial infarction and unlimited payment for coronary angioplasty and intensive care in acute coronary syndrome, but that's it. Nothing more. Only logs for the feet in the form of, for example, the aforementioned announcement on the protection of radiological procedures, when the interventional cardiologist performing the procedure on the heart cannot check the condition of the peripheral vessels at the same time. He could have been for 15 years, and he has not been for a year, he has to wait for a vascular surgeon or a radiologist.
It's not about earning, it's about whether we really have to put patients at risk. I am not saying that my colleagues will do it wrong, because they are definitely doing it well, and I do not defend them, but taking this right away from cardiologists who have more, because15 years of experience in arterial procedures exposes patients to additional hospitalizations and unnecessary suffering related to the next procedure. Atherosclerosis is a disseminated disease and such recipes have no medical justification.
But recently. I hope these recipes will change.
Due to the lack of appropriate prophylaxis, screening tests, good diagnostics and sufficiently promptly implemented treatment to prevent a heart attack. First of all, the population is aging, and at a certain age the risk of atherosclerosis and coronary heart disease is greater. Due to genetic tendencies and the way of life, atherosclerosis develops faster and affects all arteries. The consequences are serious: atherosclerosis of the coronary arteries can cause coronary artery disease, chest pains, a significant reduction in physical performance, and in the subsequent stage, a heart attack, i.e. a large damage to the heart muscle, which in turn leads to disability or even death.
Consequence Carotid atherosclerosis can be strokes, renal artery atherosclerosis causes kidney failure and very serious arterial hypertension, iliac arteriosclerosis ends with intermittent claudication, i.e. leg pain, first at rest, and then lower limb ischemia, necrosis and amputation. That is why it is so important to avoid acute coronary syndrome, but to start treatment sooner. Do not allow a heart attack, stroke or limb amputation. Only an early detection of the disease and the completion of treatment can guarantee the improvement of bad statistics. Each stage of the treatment of the patient should be planned and properly set in time, as in the oncology package. And even in the case of patients with myocardial infarction, we waste time, despite the well-developed treatment network. Meanwhile, the so-called "golden hour", median hospital delay, ie the time during which the patient is admitted to the hemodynamic laboratory. In Poland, it is 240 minutes. In Sweden - 160 minutes and in the USA - 120 minutes.
We don't educate people who wait too long to call the emergency room and cause delays themselves.
As a result, we save lives, but do not save the heart from later failure and other complications.
- Does the enacted Public He alth Act have a chance to change anything when it comes to education, at least?
She should. Risk factors for developing ischemic disease include, in addition to smoking andalcohol abuse, food high in animal fats, low physical activity and prolonged stress. We have cars, we use elevators, escalators. And he alth is declining. Recently, however, more and more is said about the influence of inflammatory factors on the development of atherosclerosis. We already have several microorganisms suspected of damaging the endothelium. Air pollution is also a very important factor. I'm glad that it is being talked about louder and louder.
- What is the most harmful?
Dust suspended. On the one hand, it leads to the development of chronic bronchitis and chronic obstructive pulmonary disease. It is this second chronic inflammation that accelerates leukocyte damage to the vascular wall, giving rise to atherosclerosis.
- Environmental pollution is a problem because we do not always have an influence on it.
True, but largely we do. Large workplaces have modernized a lot under the threat of pen alties, while many compatriots, when winter comes, use just anything in their stoves. There has not yet been a change in the awareness that poor coal and rubbish are very toxic. This is especially visible in Upper Silesia and Krakow.
- How great is the impact of low emissions on cardiovascular disease?
Huge. Please look at the map of heart attacks in the country. It coincides with the map of areas with polluted air, high dustiness. In fact, it is a strip from Gdańsk through Bydgoszcz, Łódź with accumulation in Upper Silesia, in Krakow, to Zakopane.
- Who gets atherosclerosis?
Well, practically all of us will develop this atherosclerosis to some degree. This, however, depends on many factors. In women, for example, it develops later than in men, due to the fact that sex hormones protect women from developing this disease at least until the menopause. However, smoking is a well-known and major factor in the development of this disease. Naturally, next to genetic determinants.
- Is atherosclerosis a civilization disease?
The way of life and nutrition in highly developed countries is such that it promotes the development of atherosclerosis.
- What is the earliest age we can get this disease?
Reports speak of early atherosclerosis symptoms even in infants, so we can say that we are exposed from birth. In men, it really starts after the age of 30. Even then, cholesterol deposits begin to accumulate in the vessels.
- Do Polish patients have access to the most modern methods of treating heart attacks?hearts?
Until recently, it seemed so, but now you can see that we are lagging behind more and more. I mean modern antiplatelet drugs that reduce the risk of in-stent clotting, anticoagulants that reduce the risk of bleeding during surgery, modern biodegradable stents, all those solutions that are common in the West and have not yet been reimbursed in our country. Also modern methods of unblocking arteries related to rotablation technology. They are special catheters which, like drills, enable safe passage through lesions with large calcifications, where there is a risk of atherosclerotic rupture. Balloon catheters available worldwide that release drugs into the vessel wall are not reimbursed. Therefore, due to their high costs, we cannot use them as widely as we would like.
- It seemed that cardiology did not generate problems for patients, that it is on a global level.
It is, but we unexpectedly fell into an unfavorable trend. We have already moved away from Western Europe, because mortality from heart attacks is 2-3 times higher in Poland. There is no modern heart disease treatment program. And you have to create a cardiology package really quickly, otherwise we will lose everything.
Material prepared by the "Journalists for He alth" Association, accompanying the 14th National Conference "Polish Woman in Europe", September 2015.
Worth knowingProf. dr hab. of medical sciences Paweł Buszman -co-founder and President of the Management Board of the American Heart of Poland Group, dealing with diagnostics and comprehensive treatment of heart and vascular diseases, which includes, among others Polish-American Heart Clinics and Ustroń He alth Resort.
A cardiologist who was the first in Poland to implant a stent into the patient's carotid artery in 1997. Angioplasty has been used in the world since the mid-90s.
Prof. Paweł Buszman started working in Zabrze in the 1980s, where an intensive heart attack treatment program was being created. He was taught stenting in London by prof. Ulrich Sigwart, the world's first cardiologist to insert a stent into a coronary artery. He was trained in peripheral techniques in San Antonio, Texas, where he learned procedures from a Polish cardiologist, prof. Stefan Kiesz (co-founders of the AHP group) and Dr. Palmaza - a radiologist who pioneered the use of stents.
Coronary stents were placed in Poland for the first time in Poland by a patient at the ŚlAM clinic in Zabrze in 1989 by the Dutchman Heinz Bonnier. The second doctor who did this was prof. Paweł Buszman.